Household and institutional population samples are studied in a five county area of North Carolina to estimate the true incidence and prevalence of specific psychiatric disorders according to current diagnostic criteria. The social environmental determinants of psychiatric disorder are examinded, including urban versus rural residence, stressful life events, family support, and sociodemographic factors, particularly race and economic status. This project also studies the relationship between psychiatric disorder and utilization of psychiatric, general health, and other treatment programs, including barriers to service utilization. Additional areas addressed are the validation of health service utilization by review of local hospital and outpatient clinic records and the validation of self-reports of psychotropic drug use by urine screens. The geographical area includes a large proportion of minority residents, especially rural blacks.